FIVE CASES OF PERFORATED PYOMETRA PRESENTING WITH DIFFUSE PERITONITIS

Abstract

Pyometra is a relatively rare disease to form an abscess in the uterus when drainage of discharge from the uterus is inhibited at somewhere. Besides, perforated pyometra causing peritonitis is very uncommon. From 1985 to 1993, emergency operation was undertaken for 5 cases of perforated pyometra presenting with diffuse peritonitis. They were all more than 70 years old. Severe anbdominal pain occurred suddenly in all cases and one case fell in profound shock status soon after that symptom. Diagnosis was tried to make using CT, ultrasonography and simple abdominal X-ray examination, but only 2 cases were detected as the perforated pyometra by those diagnostic aids. Histerectomy with bilateral salpingoopharectomy was carried out in cases. Histological examination revealed pyometra with inflammation and destruction of the endmetrium and myometorium without any evidence of malignancy. Postoperative course was uneventful in 4 cases. However, one case could not recover from profound shock status and died of sepsis. This disease will increasingly appear from now on when we are seeing the aged society. Any typical symptoms could not be detected before perforation of pyometra, accordingly rigorous and careful examinations are necessary for aged female patient complaining of severe abdominal pain of unknown origin.